MBA Guidelines for Cosmetic Medical and Surgical Procedures – Cosmetic Medical Procedures

ArticleGeneral, Guidelines

These guidelines have been developed by the Medical Board of Australia (the Board) under section 39 of the Health Practitioner Regulation National Law as in force in each state and territory (the National Law).

The guidelines aim to inform registered medical practitioners and the community about the Board’s expectations of medical practitioners who perform cosmetic medical and surgical procedures in Australia. These guidelines complement Good medical practice: A code of conduct for doctors in Australia (Good medical practice) and provide specific guidance for medical practitioners who perform cosmetic medical and surgical procedures. They should be read in conjunction with Good medical practice.

The new guidelines will apply to all medical practitioners, including specialist plastic surgeons, cosmetic surgeons, and cosmetic physicians, regardless of their qualifications.

These guidelines do not apply to nurses and beauty therapists who provide cosmetic procedures.

These guidelines take effect on the 1st of October 2016.

Definitions

Cosmetic medical and surgical procedures are operations and other procedures that revise or change the appearance, colour, texture, structure or position of normal bodily features with the dominant purpose of achieving what the patient perceives to be a more desirable appearance or boosting the patient’s self-esteem.

Major cosmetic medical and surgical procedures (‘cosmetic surgery’) involve cutting beneath the skin. Examples include; breast augmentation, breast reduction, rhinoplasty, surgical face lifts and liposuction.

Minor (non-surgical) cosmetic medical procedures do not involve cutting beneath the skin, but may involve piercing the skin. Examples include: non-surgical cosmetic varicose vein treatment, laser skin treatments, use of CO2 lasers to cut the skin, mole removal for purposes of appearance, laser hair removal, dermabrasion, chemical peels, injections, microsclerotherapy and hair replacement therapy.

Surgery or a procedure may be medically justified if it involves the restoration, correction or improvement in the shape and appearance of body structures that are defective or damaged at birth or by injury, disease, growth or development for either functional or psychological reasons. Surgery and procedures that have a medical justification and which may also lead to improvement in appearance are excluded from the definition.

The medical specialty of plastic surgery includes both cosmetic surgery and reconstructive surgery. Reconstructive surgery differs from cosmetic surgery as, while it incorporates aesthetic techniques, it restores form and function as well as normality of appearance. These guidelines apply to plastic surgery when it is performed only for cosmetic reasons. They do not apply to reconstructive surgery.

Section 2 – Patient Assessment

The patient should be referred for evaluation to a psychologist, psychiatrist or general practitioner, who works independently of the medical practitioner who will perform the procedure, if there are indications that the patient has significant underlying psychological problems which may make them an unsuitable candidate for the procedure.

Other than for minor procedures that do not involve cutting beneath the skin, there should be a cooling off period of at least seven days between the patient giving informed consent and the procedure. The duration of the cooling off period should take into consideration the nature of the procedure and the associated risks.

A medical practitioner should decline to perform a cosmetic procedure if they believe that it is not in the best interests of the patient.

Section 3 – Additional responsibilities when providing cosmetic medical and surgical procedures for patients under the age of 18

The medical practitioner must assess and be satisfied by the patient’s capacity to consent to the procedure.

The medical practitioner should, to the extent that it is practicable, have regard for the views of a parent of the patient under 18, including whether the parent supports the procedure being performed.

Before any major procedure, all patients under the age of 18 must be referred for evaluation to a psychologist, psychiatrist or general practitioner, who works independently of the medical practitioner who will perform the procedure, to identify any significant underlying psychological problems which may make them an unsuitable candidate for the procedure.

For minor procedures, referral for evaluation by a psychologist, psychiatrist or general practitioner, who works independently of the medical practitioner providing the procedure, is not required for patients under the age of 18, unless there are indications that the patient has significant underlying psychological problems which may make them an unsuitable candidate for the procedure.

For the patient under the age of 18, there must be a cooling off period between the informed consent and the procedure being performed:

  • for minor procedures, the cooling off period must be a minimum of seven days
  • for major procedures, the cooling off period must be a minimum of three months.

The patient should be encouraged to discuss why they want to have the procedure with their general practitioner during the cooling off period.

The medical practitioner who will perform the procedure must provide the patient with enough information for them to make an informed decision about whether to have the procedure. The practitioner should also provide written information in plain language. The information must include:

  • what the procedure involves;
  • whether the procedure is new or experimental;
  • the range of possible outcomes of the procedure;
  • the risks and possible complications associated with the procedure;
  • the possibility of the need for revision surgery or further treatment in the short term (e.g. rejection of implants) or the long term (e.g. replacement of implants after expiry date);
  • recovery times and specific requirements during the recovery period;
  • the medical practitioner’s qualifications and experience;
  • total cost including details of deposits required and payment dates, refund of deposits,  payments for follow-up care and possible further costs for revision surgery or additional treatment, and;
  • the complaints process and how to access it.

Informed consent must be obtained by the medical practitioner who will perform the procedure.

Other than for minor procedures, informed consent should be obtained in a pre-procedure consultation at least seven days before the day of the procedure and reconfirmed on the day of the procedure and documented appropriately.

Section 5 – Patient Management

The medical practitioner who will perform the procedure is responsible for the management of the patient, including ensuring the patient receives appropriate post-procedure care.

If the medical practitioner who performed the procedure is not personally available to provide post-procedure care, they must have formal alternative arrangements in place. These arrangements should be made in advance where possible, and made known to the patient, other treating practitioners and the relevant facility or hospital.

There should be protocols in place for managing complications and emergencies that may arise during the procedure or in the immediate post-procedure phase.

Written instructions must be given to the patient on discharge including:

  • the contact details for the medical practitioner who performed the procedure;
  • alternative contact details in case the medical practitioner is not available;
  • the usual range of post-procedure symptoms;
  • instructions for the patient if they experience unusual pain or symptoms;
  • instructions for medication and self-care, and;
  • dates and details of follow-up visits.
Media Statement

View Full MBA Media Statement

Share

Break and Enter – Person of Interest

ArticleGeneral

Person of interest.

The person shown in the video stills below is wanted for questioning by Redfern Local Area Command police officers for the break and enter at Green Square Dermatology on Sunday, 2nd October 2016.

The person in question entered the premises without permission through the 1st floor balcony and was interrupted by the Business Manager and his 5 year old son a few minutes later. The Business Manager gave chase and the unknown person disappeared out through the balcony.

If anyone has information regarding the person shown in this photo then please contact Green Square Dermatology (02 92269600) or Redfern Police Station (02 83035199 – Officers L. Andrews or P. Rullis).

Person of interest.
Person of Interest.
Person of Interest.

Brave boy who listened to dad and stayed calm.

The Business Manager’s son did a great job by listening to dad and staying in the reception area, turning on the lights while dad gave chase after the intruder.

Break and Enter - Brave Boy
Break and Enter - Brave Boy
Break and Enter - Brave Boy

Share

Hackers Mount Ransomware Attack On Dermatology Practice

ArticleGeneral

Author: Joseph Goedert
Information Management, August 2016

Professional Dermatology Care in Reston, Va., is notifying about 13,237 patients after suffering a ransomware attack in June.

The practice discovered the breach on its network server on June 27; the attack turned out to be a ransomware incursion that encrypted patient data. “PDC believes the criminals’ motive was to extract money from the company in order to decrypt data, rather than for the misuse of patient data,” according to a letter to patients.

Whether ransom was paid or the attack was mitigated, however, is not clear; a spokesperson for the practice did not respond to a request for more information.

Nicolae Blatt in his medical office in Tirgu Mures, in the 1920s

Protected health information at risk included patient names, addresses, dates of birth, Social Security numbers, Medicare numbers, and medical and billing records.

Professional Dermatology is offering identity protection services and urging patients to check credit reports. The provider has undertaken several steps to increase security, including installing a new firewall and additional malware protection.

The breach is posted on the HHS Office for Civil Rights’ web site of breaches that have affected the health information of more than 500 individuals.

View Professional Dermatology Care Data Breach Notice

View Full Article

Share

Pokémon GO

ArticleGeneral

Pokémon GO is the latest craze in location-based tracking games to hit our mobile devices. Surprisingly, it’s not just the kids that love to play this game but the adults too!

We’re lucky enough to have several PokéStops in the area, and even more fortunate to have one accessible from within our clinic. The “Wall Flower Art” PokéStop is literally a stone’s throw away from our clinic, so waiting patients (and staff) have been able to catch Pokémon and collect items without having to move!

Pokémon GO - 20a Danks Street WATERLOO NSW 2017

Wall Flower Art
Pokémon GO - 20a Danks Street WATERLOO NSW 2017Pokémon GO - 20a Danks Street WATERLOO NSW 2017Pokémon GO - 20a Danks Street WATERLOO NSW 2017

Share

Studio Ghibli comes to work!

ArticleGeneral

This video shows The ART of WALL crew hard at work developing a Studio Ghibli inspired design for our clinic. A week of painting, drop sheets, buckets, brushes and chaos finally gave way to the fantastic mural that now wraps our back office area.

Our back office provides a welcome contrast to the rest of the clinic where staff and their children can watch TV and have their breaks against painted blue skies and green hills.

It’s been over a year since it was commissioned and we never get tired of looking at the great art and “not an office” colour scheme!.

Share

Life expectancy after Mohs surgery in elderly patients

ArticleGeneral, Research

Article: Life expectancy after Mohs micrographic surgery in patients aged 90 years and older
Authors: Amy Delaney; Ikue Shimizu; Leonard H. Goldberg; Deborah F. MacFarlane
Journal of the American Academy of Dermatology, November 2012

Background

The population of people aged 90 years and older is expected to more than triple by 2050. The incidence of skin cancers is increasing.

Objective

We sought to determine whether treatment of patients aged 90 years and older with skin cancer by Mohs micrographic surgery (MMS) changed their survival.

sweet old kiss

Methods

A group of 214 patients aged 90 years and older who underwent MMS from July 1997 to May 2006 was identified. Patient gender, age, tumor type, size, site, defect size, number of MMS stages, and surgical repair were recorded. Comorbid medical conditions were assessed using the Charlson index. Actual survival was compared with expected length of survival using life tables. Data were analyzed by the Kaplan-Meier method with log rank significance tests.

Results

Average patient age was 92.3 years. All patients tolerated the procedures well with no deaths within 1 month after surgery. Median survival after surgery was 36.9 months. Tumor characteristics, defect size, number of surgical stages, and closure type did not affect survival. There was no significant difference in survival based on comorbidities according to Charlson scores. Instantaneous mortality hazard was highest 2 to 3 years after surgery.

Limitations

Specific causes of death were not accessible.

Conclusion

This growing section of the population may safely undergo MMS.

View Full Article

DOI: http://dx.doi.org/10.1016/j.jaad.2012.10.016

Share